Sabrina Piedimonte1, Nicholas Czuzoj-Shulman2, Walter Gotlieb3, Haim Arie Abenhaim4. 1. Department of Obstetrics and Gynecology (Drs Piedimonte and Abenhaim), Jewish General Hospital, Montreal, Quebec, Canada. 2. Center for Clinical Epidemiology and Community Studies (Mr Czuzoj-Shulman and Dr Abenhaim), Jewish General Hospital, Montreal, Quebec, Canada. 3. Department of Gynecologic Oncology (Dr Gotlieb), Jewish General Hospital, Montreal, Quebec, Canada. 4. Department of Obstetrics and Gynecology (Drs Piedimonte and Abenhaim), Jewish General Hospital, Montreal, Quebec, Canada; Center for Clinical Epidemiology and Community Studies (Mr Czuzoj-Shulman and Dr Abenhaim), Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: haim.abenhaim@mcgill.ca.
Abstract
STUDY OBJECTIVE: To compare the use of robotic radical hysterectomy (RRH) and abdominal radical hysterectomy (ARH) in the United States, with secondary outcomes of perioperative complications, hospital length of stay (LOS), immediate postoperative mortality, cost and a subanalysis compared with laparoscopic radical hysterectomy (LRH). DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Data from the National Inpatient Sample (NIS), a government-funded database of hospitalization in the United States. PATIENTS AND INTERVENTIONS: All women with cervical cancer undergoing RH between 2008 and 2015 in the United States and included in the NIS database. MEASUREMENTS AND MAIN RESULTS: Trends in surgical modality, baseline characteristics, LOS, perioperative outcomes, mortality, and hospital charges were compared between RRH and ARH. Regression models were adjusted for baseline characteristics. Among 41,317 women with cervical cancer, 3563 underwent RH, including 21.0% with a robotic procedure, 6.5% with a laparoscopic procedure, and 72.5% with open surgery. The annual rates of ARH declined significantly over the study period, whereas those of RRH increased. Baseline characteristics were comparable between the RRH and ARH groups. Compared with the ARH group, women undergoing RRH had a lower rate of cumulative postoperative complications (18.16% vs 21.21%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.6-1.0; p = .05), including lower rates of wound infection (0.27% vs 1.82%; OR, 0.14; 95% CI, 0.03-0.6; p < .01), sepsis (0.27% vs 1.20%; OR, 0.22; 95% CI, 0.05-0.9; p = .03), fever (1.87% vs 4.06%; OR, 0.44, 95% CI, 0.3-0.8; p < .01), and ileus (2.8% vs 9.13%; OR, 0.28; 95% CI, 0.12-0.4; p < .01). The LOS was significantly shorter in the RRH group (median, 2 days vs 4 days; p < .01). The total median hospitalization charge was $47,218 for the RRH group, compared with $38,877 for the ARH group (p < .01). CONCLUSION: RRH is being increasingly performed in the United States and is associated with shorter LOS and less postoperative morbidity; however, long-term oncologic outcomes require additional attention.
STUDY OBJECTIVE: To compare the use of robotic radical hysterectomy (RRH) and abdominal radical hysterectomy (ARH) in the United States, with secondary outcomes of perioperative complications, hospital length of stay (LOS), immediate postoperative mortality, cost and a subanalysis compared with laparoscopic radical hysterectomy (LRH). DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Data from the National Inpatient Sample (NIS), a government-funded database of hospitalization in the United States. PATIENTS AND INTERVENTIONS: All women with cervical cancer undergoing RH between 2008 and 2015 in the United States and included in the NIS database. MEASUREMENTS AND MAIN RESULTS: Trends in surgical modality, baseline characteristics, LOS, perioperative outcomes, mortality, and hospital charges were compared between RRH and ARH. Regression models were adjusted for baseline characteristics. Among 41,317 women with cervical cancer, 3563 underwent RH, including 21.0% with a robotic procedure, 6.5% with a laparoscopic procedure, and 72.5% with open surgery. The annual rates of ARH declined significantly over the study period, whereas those of RRH increased. Baseline characteristics were comparable between the RRH and ARH groups. Compared with the ARH group, women undergoing RRH had a lower rate of cumulative postoperative complications (18.16% vs 21.21%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.6-1.0; p = .05), including lower rates of wound infection (0.27% vs 1.82%; OR, 0.14; 95% CI, 0.03-0.6; p < .01), sepsis (0.27% vs 1.20%; OR, 0.22; 95% CI, 0.05-0.9; p = .03), fever (1.87% vs 4.06%; OR, 0.44, 95% CI, 0.3-0.8; p < .01), and ileus (2.8% vs 9.13%; OR, 0.28; 95% CI, 0.12-0.4; p < .01). The LOS was significantly shorter in the RRH group (median, 2 days vs 4 days; p < .01). The total median hospitalization charge was $47,218 for the RRH group, compared with $38,877 for the ARH group (p < .01). CONCLUSION:RRH is being increasingly performed in the United States and is associated with shorter LOS and less postoperative morbidity; however, long-term oncologic outcomes require additional attention.
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Erica J Chang; Maximilian Klar; Kazuhide Matsushima; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: Gynecol Oncol Date: 2020-05-27 Impact factor: 5.482
Authors: Chia-Hao Liu; Yu-Chieh Lee; Jeff Chien-Fu Lin; I-San Chan; Na-Rong Lee; Wen-Hsun Chang; Wei-Min Liu; Peng-Hui Wang Journal: Int J Environ Res Public Health Date: 2019-10-11 Impact factor: 3.390
Authors: Igt Baeten; J P Hoogendam; Hwr Schreuder; I M Jürgenliemk-Schulz; Rhm Verheijen; R P Zweemer; C G Gerestein Journal: BJOG Date: 2020-07-28 Impact factor: 6.531